Diagnostic oral food challenges in the tertiary paediatric allergy clinic in the UK

Abstract

Objective – To assess outcomes of oral food challenges (OFC) and to investigate food reintroduction success among children who had negative OFC within single UK tertiary paediatric allergy centre.

Methods – This study was a retrospective audit of OFC conducted over a 1 year period among children aged 0 to 18 years at Leeds’s Children’s Hospital who were referred for assessment of their food allergy. Data were collected on demographics, clinical history, challenge outcome and success of reintroduction

Results – Out of 363 challenges conducted 282 (77.7%) had a negative outcome. Of 70 positive challenges, 2 were anaphylaxis due to cow’s milk. Positive challenge outcome was more common in children with a history of atopic eczema (23.4% vs 13.2%, p=0.03) and those who avoided multiple food allergens (p=0.007). The majority of nut challenges (93.9%) tended to be negative. Following negative challenge, data on reintroduction was available on 188/282 children. The majority of children (82.4.2%) were successful in reintroducing allergen into diet. The most common reason for failure of reintroduction of allergen among 33 (17.6%) children with negative challenge was food aversion and delayed reactions.

Conclusion – The majority of OFC conducted for assessment of food allergy in children are negative. Although a significant proportion of children experience reaction during challenge, systemic reactions during the challenge are relatively rare. Timely recognition of resolution of allergy is important due to its impact on overall health. The majority of children with negative challenge outcome have successfully reintroduced the allergen back in their diets. Clinicians need to discuss and proactively manage patient and families’ expectations before and after negative challenge.